Headache (cont.)

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

When should I seek medical care for a headache?

The "worst headache of your life." This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a subarachnoid hemorrhage due to a ruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms. Too often, patients are prompted to use this expression by a health care professional and do not routinely volunteer the phrase.

Different than their usual headaches

Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity

Associated with fever or stiff neck. A stiff neck may be due to meningitis or blood from a ruptured aneurysm. However, most patients who complain of a stiff neck have muscle spasm and inflammation as the cause.

Associated with seizures

Associated with recent head trauma or a fall

Associated with changes in vision, speech, or behavior

Associated with weakness or change in sensation on one side of their body that may be a sign of stroke.

Not responding to treatment and is getting worse

Requires more than the recommended dose of over-the-counter medications for pain

Disabling and interfering with work and quality of life

Medically reviewed by Jon Glass, MD; American board of Psychiatry and Neurology

Steiner, T. J., et al. "Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache." 3rd Edition. British Association for the Study of Headache. 18 Jan. 2007.